Inflammation and Chronic Pain: Influencing Culture

To know a patient suffering from a chronic inflammatory illness is to know an individual who in many ways has the opportunity to experience a new triumph every day. These are the individuals with inflammatory rheumatoid arthritis, who awaken in the morning unsure if they will be able to pick up the toothbrush. These are the patients with the inflammatory myopathy, dermatomyositis, who are unsure if they will have the strength to rise from a chair without assistance. These are the sufferers of scleroderma, wondering if their skin can become any more hide-bound.

For those not living with such illnesses, these seem trivial considerations. However, for those afflicted with these autoimmune inflammatory disorders, the right answer to their silent questions can bring a sense of satisfaction many of us might never know.

It is one of the ironies of life that the human being often must endure such torture and pain in order to renew the commitment to humanity so often taken for granted: From the deformed and the decrepit, society is taught lessons in courage, humility, mindfulness, perseverance, and, yes, optimism.• Consider the feat accomplished by Michelangelo in painting the Sistine ceiling. There are references to episodes of depression and melancholy, the de facto universal ailment of creative minds; but such emotions may have been secondary to the chronic and recurrent inflammatory arthritis, gout. In a letter to his nephew Lionardo di Buonarroto Simoni, Michelangelo writes: "I haven't been able to do so before, because of the cruelest pain I've had in one foot, which has prevented me from going out and has been a nuisance to me in a number of ways. They say it's a kind of gout...". Michelangelo may have had a hereditary form of a uric acid disorder, accounting for much of his life-long chronic illnesses (gout and apparent kidney disease). He also wrote, "I cannot use my hands to write"; however, he was still able to hold a chisel and hammer in the palm of hand--much easier for the arthritic patient when compared to holding a pen between the fingers.• A 1981 article in the Journal of the American Medical Association discusses the accomplishments of Peter Paul Rubens. In 1606, he developed pleuritis, inflammation of the protective lining of the lungs, which can accompany rheumatoid arthritis. A letter in 1640 noted that "his hands are paralyzed for more than one month without hope he might still use his brushes". A close analysis of Rubens's paintings over the last thirty years of his life reveals the deformities of arthritis depicted in various subjects, chronologically documenting the natural progression of the disease. Look at the painting, "The Holy Family with St. Anne": The left arm of St. Anne, resting on Mary's shoulder, is a classic depiction of a typical swollen wrist seen in an inflammatory arthritis such as rheumatoid arthritis.• The scleroderma of Paul Klee, with its relentless progression of tightening fibrosis, offers an explanation for the changes of theme (more somber), form (more contracted), and color (overwhelmingly black and brown) of his canvasses towards the end of his life,• Mexican painter Frida Kahlo may have had lupus and a chronic pain syndrome. During periods of immobilization she utilized a special easel, with a mirror attached to the canopy of her bed, allowing her to focus on herself. Anguish and pain loom as the main themes of her artistic expression. Trotsky is quoted as saying that "she painted the human condition-alone and in pain".• According to "Art, History, and the Antiquity of the Rheumatic Diseases", Pierre-Auguste Renoir developed deforming and incapacitating rheumatoid arthritis. Still, unable to reach and barely able to lift, with a truncated palette, he is quoted as saying, "In the battle I have lost my legs, I cannot sit, get up, or take a step without being helped...I am so lucky to still have painting which, even very late in life, still offers illusions and sometimes joy".